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Int J Clin Exp Pathol 2013;6(12):2979-2988

Case Report
Diffuse large B-cell lymphoma of the uterus suspected of having transformed from a
marginal zone B-cell lymphoma harboring trisomy 18: a case report and review of the
literature

Kei-Ji Sugimoto, Hidenori Imai, Asami Shimada, Mutsumi Wakabayashi, Yasunobu Sekiguchi, Noriko Nakamura, Tomohiro Sawada, Hiroshi
Izumi, Yasunori Ota, Norio Komatsu, Masaaki Noguchi

Department of Hematology, Juntendo University Urayasu Hospital, Urayasu, Japan; Department of Hematology, Juntendo University School of
Medicine, Tokyo, Japan; Department of Clinical Laboratory, Juntendo University Urayasu Hospital, Urayasu, Japan; Department of Pathology,
Juntendo University Urayasu Hospital, Urayasu, Japan; Department of Pathology, Research Hospital, The Institute of Medical Science, The
University of Tokyo, Japan

Received October 3, 2013; Accepted October 27, 2013; Epub November 15, 2013; Published December 1, 2013

Abstract: The patient was a 72-year-old female with the chief complaint of abdominal fullness. A giant primary myoma of the uterine cervix was
suspected, and total hysterectomy was performed. Based on a postoperative histopathological examination of the tumor a diagnosis of diffuse
large B-cell lymphoma (DLBCL) was made in the uterus and a mass in the greater omentum was diagnosed as a marginal zone B-cell
lymphoma (MZBCL). No flow-cytometry studies or chromosome or gene examinations were performed on a fresh specimen. The results of an
examination of a paraffin block histopathology specimen by fluorescence in-situ hybridization (FISH) showed no mucosa associated lymphoid
tissue lymphoma translocation gene 1 (MALT1) (18q21.1), B-cell lymphoma 2 (BCL2) (18q21.3), or BCL6 (3q27) split signals in either the
uterus or the greater omentum, however, trisomy 18 was detected in approximately 50%-70% of the tumor cells in both the uterus and the
greater omentum. Trisomy 18 was present in around 15-33% of the DLBCL cells and MZBCL cells. These findings suggested a strong
possibility that the tumor cells in the uterus and greater omentum were the same clone and that transformation from MZBCL to DLBCL had
occurred. Since DLBCLs that result from a transformation usually have a worse outcome than de novo DLBCLs, even when a DLBCL seems to
have originated in the uterus the surrounding tissue should always be examined, and caution should be exercised in regard to transformation
from a low-grade B-cell lymphoma to a DLBCL. (IJCEP1310011).

Keywords: Marginal zone lymphoma, diffuse large B-cell lymphoma, transformation, trisomy 18, uterus, greater omentum

Address correspondence to: Dr. Kei-Ji Sugimoto, Department of Hematology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu
279-0021, Japan. Tel: +81-47-353-3111; Fax: +81-47-381-5054; E-mail: keijis@juntendo.ac.jp